Safe Sleep

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​​​​​​​​​SIDS is the leading cause of death among babies between 1 month and 1 year of age. The American Academy of Pediatrics is a proud partner in the National Back to Sleep Campaign spearheaded by the National Institute for Child and Human Development (NICHD).

Back to Sleep, Tummy to Play. Although babies should be placed on their backs to sleep, supervised tummy time is an important part of healthy development. Read all about tummy time and how to make it fun for your baby in this brochure.

Milwaukee Media​​ development. Some of the material is not necessarily aligned with our strategy but at the very least showcases different ways of presenting messaging.​​

Frequently Asked Questions

What is the rationale behind recommending room sharing?

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Our recommendation remains similar to the 2011 statement, “Infants should sleep in parents’ room, close to parents’ bed, but on a separate surface designed for infants. Ideally, for the first year of life, but at least for the first 6 months.”

The evidence supporting this comes from three case-controlled studies in Scotland, New Zealand, and England. All three find a significantly increased SIDS risk (adjusted odds ratio 2.86-10.49) when an infant is sleeping alone in a separate room compared to room sharing. More recent data from New Zealand has found a 64% protection rate with room sharing compared with solitary room sleeping. However, it is important to note none of these studies stratified by age in months; therefore, the 2011 recommendation was that infants room share without bed sharing up to one year of age.

Ninety percent of sleep related deaths occur in the first 6 months of life. Most recent analyses of case-control studies and registry databases show sleep location is critical in the first few months of life. Therefore, Task Force on SIDS has emphasized the first 6 months as the most important period of time with the most potential for improvement in SIDS rates.

An infant’s ability to arouse is critical physiologically - and a leading hypothesis is that failure to arouse makes infants vulnerable to SIDS. Room sharing infants have more small awakenings (for instance, when the parent moves, the baby stirs a little bit - may not wake up fully but has a little arousal) during the night. It has been postulated that room sharing without bed sharing may offer a protective effect from the small awakenings. Further, room sharing facilitates continued breastfeeding, another measure that reduces the risk.

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What are the implications for pediatricians sitting on a Child Fatality Review board?

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As with the 2011 policy statement, these updated recommendations can be used as the cornerstone for safe sleep policy recommendations from child fatality review teams. See the Section on Child Death Review and Prevention safe sleep page for AAP publications, resources for families, and example state safe sleep campaign strategies.

Additionally, there is an opportunity for pediatricians to advocate for standardization of SIDS diagnosis and scene investigation in their state or district. The variability in case investigation procedures across states, counties, and police departments significantly hampers our ability to understand and study the cause and risk factors for SIDS. More specifically, it hampers a child fatality review board to accurately determine prevention recommendations. The CDC offers Guidelines for Death Scene Investigation of Sudden, Unexplained Infant Deaths. State examples of written protocol for SUIDS scene investigation can be found in California, Minnesota, Missouri, and New Mexico.

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What is the AAP's position on baby box initiatives to provide a safe sleep environment for the youngest infants?

​The Finnish baby box has captured attention in the past couple of years. Currently, there is insufficient data on the role cardboard boxes play in reducing infant mortality. Finland does experience a low infant mortality rate but they have never collected data on the possible role of cardboard boxes. There are many factors that may contribute to the country’s low infant mortality rate: women receive excellent prenatal care; there is very little smoking in the country; and almost all babies sleep on their backs. Currently, there are randomized controlled trials being conducted in New Zealand and Australia regarding the use of boxes (not necessarily cardboard boxes but flax or woven boxes). However, none of these studies have been published yet. ​

What are the safety implications of swaddling and sleep?

​Unfortunately, we have no evidence to recommend swaddling as a strategy to reduce SIDS. We do know the baby is at a very high risk if the baby is swaddled and then placed prone or rolls into the prone position. The swaddle restricts their movement, and it is difficult for them to get out of the stomach position when they are swaddled. For that reason, the Task Force on SIDS recommends once the baby is starting to roll, swaddling be stopped.​

Are “side sleepers” or “in-bed sleepers” safe?

​The bed side sleeper is a product attached to the side of the parental bed, for which there are safety standards. The in-bed sleeper, a product meant to be placed in the parental bed, does not have safety standards. There are no published data examining the association between sleepers and SIDS or unintentional injury or death. For that reason, the Task Force on SIDS does not take a position on either one. However, if parents are asking for guidance, it is important people understand that bed side sleepers have safety standards. ​